OBJECTIVE: The aim of this study was to describe results of a representative sample of children who have undergone cataract surgery in schools for the blind in 4 African countries. DESIGN: Cross-sectional study. PARTICIPANTS: Children enrolled at schools for the blind in Kenya, Malawi, Tanzania, and Uganda. METHODS: We used a population-proportional-to-size methodology to select a representative sample of schools for the blind and annexes and included all the children attending the selected schools. Trained teams using standardized examination methods and a modified World Health Organization form examined the children. The form was modified specifically to collect information on outcomes of cataract surgery. MAIN OUTCOME MEASURES: Operative status and postoperative visual acuity. RESULTS: Of 1062 children examined, 196 (18%) had undergone cataract surgery or had cataract as the major cause of visual impairment; 140 (71%) had bilateral surgery, 24 (12%) had unilateral surgery, and 32 (16%) had not had surgery. Of operated eyes, 118 (41%) had visual acuity > or =20/200. Intraocular lenses were implanted in 65% of the operated eyes. Eyes with intraocular lens were more likely to have better vision than those without (P for trend = 0.04). Amblyopia was the most common cause of poor visual acuity in children who had undergone cataract surgery. CONCLUSIONS: The number of children in the schools who receive cataract surgery has increased greatly since 1995. The high rate of amblyopia highlights the critical need for programs to find children earlier and to ensure adequate follow-up after surgery. Without such programs, the value of training pediatric surgeons will not be fully realized. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

PURPOSE: To determine the causes of severe visual impairment and blindness in children attending schools for the blind in Kenya, Malawi, Uganda, and Tanzania and to compare the findings with those of a 1994 study. METHODS: Children attending schools for the blind or annexes in 4 eastern African countries were examined. The major anatomical site of and underlying etiology of severe visual impairment and blindness was recorded using the standardized World Health Organization (WHO) reporting form. RESULTS: A total of 1062 children aged below 16 years were examined of whom 701 (65.2%) had severe visual impairment or blindness. The major anatomical sites of visual loss overall (% and 95% CI) were cornea scar/phthisis bulbi (19%,16.1-21.9), whole globe lesions (15.7%,13.0-18.4), retina (15.4 %, 12.7-18.1), lens related disorders (13.1%, 10.7-15.5), and optic nerve disorders (12.3%, 9.9-14.7). Corneal scar/phthisis was not distributed equally among the countries and was highest in Malawi, similar to findings in 1995. The major etiology of visual loss was childhood factors (29.9%) and an estimated 40% of severe visual impairment and blindness was due to potentially avoidable causes. CONCLUSION: The major causes of severe visual impairment and blindness overall have not changed appreciably since 1995. There are important differences among countries, however, and using overall estimates for planning may be misleading.

BACKGROUND: Many visually impaired children can learn to read print with appropriate training and simple visual aids. This may allow them to attend normal schools and to be integrated into society, which has lifelong benefits. Yet, in Africa, many visually impaired children are enrolled in special schools and taught only Braille. The purpose of this analysis was to document the extent of inappropriate enrollment of visually impaired children in special schools and annexes for the blind in four African countries. METHODS: Schools were selected through a population-proportional-to-size method so that they would represent all children attending special schools in Kenya, Malawi, Tanzania and Uganda. Children were examined by ophthalmologists trained in standardised methods to determine visual acuity and the cause of decreased acuity. RESULTS: Of 1062 children examined in special schools and annexes for the blind, 361 (34%, 95% CI 31.2, 36.8) had visual acuity >or=6/60; the most common cause of visual impairment was retinal disease. Of the 120 children with normal vision (>or=6/18), 69 (57.5%) had two normal eyes, 21 (17.5%) had an obvious ocular disfigurement in the fellow eye and 10 (8.4%) had had successful cataract surgery. CONCLUSIONS: In these countries, many children are placed inappropriately in special schools and annexes for the blind. The reasons are multiple and to rectify the situation will require advocacy and cooperation between ministries of health and education.

To determine the magnitude and pattern of significant refractive errors in primary school children in Kilungu division of Makueni District, Kenya. Design: A cross – sectional primary school based study. Setting: Eight (8) Primary school in Kilungu division of Makueni District, Kenya. Target population: 1439 Primary school pupils aged between 12 and 15 years. Results: The prevalence of significant refractive error was 5.2%, 75/1439, (95% CI) being responsible for 92.6 % of all causes of poor eyesight. Hypermetropia accounted for 3.2% (95% CI), myopia 1.7% (95% CI) and astigmatism 0.3% (95% CI) of refractive errors. Myopia was more likely to be present in the pupils aged 14 to 15 years than those aged 12 to 13 years with OR 2.9 (0.1 – 9.2) which was statistically significant (p = 0.022). Conclusion: The overall prevalence of significant refractive errors in pupils aged 12 to 15 years in Makueni's Kilungu division at 5.2% (95% CI) was high enough to justify a regular school eye screening in primary schools in Kenya.

Department of Ophthalmology, College of Health Sciences, University of Nairobi, Nairobi, Kenya. OBJECTIVES: To describe the epidemiology, referral system and visual outcomes of eye injuries in children. DESIGN: Retrospective case series. SETTING: Kenyatta National Hospital (KNH) Nairobi, Kenya. SUBJECTS: Children aged upto 15 years with eye injuries hospitalised between January 1 st, 2000 and December 31st, 2004. RESULTS: There were 182 cases. Male: female ratio was 2:1. Median age was seven years (IQR 4-10) with bimodal peaks at four and seven years. The most common cause (35%) was sticks. One hundred and twenty seven cases (70%) were open- globe injuries. One hundred and fourty one (77%) presented with visual acuity worse than 6/60 seven eyes were badly damaged and were removed (evisceration enucleation). Ninety five children (52%) were referred from Central and Eastern provinces while 87 (48%) were from Nairobi province. Most [26 (31%)] cases in Nairobi were from Kibera, Dandora and Kariobangi. Median duration between injury and arrival at first medical facility was one day but three days from injury to KNH after referral. Only 29% got tetanus toxoid, antibiotics, analgesics or eyepads at the referring facility. Median hospitalisation was seven days with a median bill of KSh 5,275/= (US$ 70.00). Fourty four children (24%) had their bills waived for inability to pay. At the last recorded follow-up 81 (57%) children had better visual acuity, 16.9% had light perception (PL). Corneal scar was the most common complication. CONCLUSIONS: Eye injuries in KNH are severe, mostly affecting pre-school children from low-income settings. There is delay in arriving at KNH and inadequate care at the referring centres. Outcomes were poor although better than on admission. This may affect education, careers and quality-of-life. Injury-prevention programmes are recommended. PMID: 18543526 [PubMed - indexed for MEDLINE]

Results: A total of 208 HIV infected children were examined. The overall prevalence of ocular fi ndings was 67.3% (140 patients). 113 patients (54.3%) of the patients were on ARV therapy. The most common finding was adnexal lesions observed in 40.9% of the patients, followed by posterior segment findings in 31.3%. Conjunctival microvasculopathy (30 patients,14.4%), allergic conjunctivitis (27 patients, 13.0%) and molluscum contagiosum 12 patients, 5.8%) were the main adnexal findings. Five cases (2.4%) of infectious conjunctivitis, 4 cases (1.9%) of herpes zoster ophthalmicus (HZO) and conjunctival growth were also recorded. Keratoconjunctivitis (6 patients, 2.9%), anterior uveitis (6 patients, 2.9%), and corneal ulcer (3 patients, 1.4%) were the main anterior segment findings. Peripheral retinal perivasculitis (28 patients, 13.5%) was the commonest posterior segment finding, followed by cotton wool spots (18 patients, 8.7%) and presumed retinal pigment epitheliopathy (18 patients, 8.7%) . Two cases of white retinal infiltrate associated with frosted branch vasculitis and 2 cases of focal retinal haemorrhages were also observed. Tuberculosis was the major systemic finding (93 patients, 44.7%). This study found that ocular findings are directly related to the duration of exposure to HIV infection (age), to the severity of clinical state of the disease (WHO clinical staging)and to the severity of immune suppression (CD4 count).

Conclusion: The results of this study suggest a high prevalence of ocular findings in Kenyan children with HIV/AIDS. Retinal perivasculitis was the commonest retinal finding observed. Further studies are needed to investigate the unusual fi ndings of retinal pigment epitheliopathy observed in this study.

{ Mansa General Hospital, P.O. Box 710156, Chembe Road, Mansa, Luapula, Zambia. OBJECTIVES: To determine the prevalence and pattern of refractive errors among African type 2 diabetes mellitus patients and establish the relationship between baseline refractive status and degree of glycaemic control. DESIGN: A hospital based cross sectional study. SETTING: Diabetic medical and eye clinics at Kenyatta National Hospital (KNH). SUBJECTS: Ninety six type 2 diabetes mellitus patients. RESULTS: Ninety six patients aged 28 to 76 years were examined. The male to female ratio was 1:1.5 and about half of the patients (52.1%) had good glycaemic control. The prevalence of myopia was 39.5% and that of hypermetropia was 19.0%. Twenty two percent of the study patients had mild diabetic retinopathy (DR). Of the eyes with DR, 20% (15/75) were myopic, 19.4% (7/36) were hypermetropic and 26.6% (21/79) were emmetropic. There was no statistically significant correlation between baseline refractive status with DR (p = 0.358), or HBA1C (glycosylated haemoglobin) (rho = 0.130